Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

Wound repair and regeneration comprise a complex process of biological and molecular events that consists of cell migration and proliferation, along with extracellular matrix deposition and remodeling. Unfortunately, not all wounds progress through healing easily. Certain pathophysiologic and metabolic conditions can alter the course of healing and impair or delay it, resulting in chronic, nonhealing wounds. The costs to treat nonhealing wounds can be high, and the patient’s quality of life can be impacted by any related loss of mobility or productivity. For these reasons, advanced wound care modalities and products may be introduced to help address underlying factors that impair the healing process.

Chronic and complex wounds present a formidable challenge in health care. Nonhealing wounds impact approximately 1% of the world's population yet account for more than 2% to 4% of health care expenses. Wounds that require additional clinical efforts often include those that are chronic and resistant to therapy, those with increased risk, and those that reduce the patient's quality of life.

Christine Miller, DPM, PhD

The role of nutrition in wound healing has been heavily explored since the early part of the 20th century. Addressing the proper balance of both macronutrients and micronutrients is a crucial part of the systemic treatment plan for patients with chronic wounds. Nutrition professionals are often highly valued members of any multidisciplinary healing team. There can often be adverse consequences of malnutrition, such as compromised immune systems and increases in hospital readmission rates. As modern-day clinicians with access to advanced therapies, we may think that adding nutrient supplementation to a care regimen is a contemporary concept, but in reality it is steeped in history.